Evidence-based spine-care journal最新文献

{"title":"Incidence of blunt cerebrovascular injuries associated with craniocervical distraction injuries.","authors":"Noojan Kazemi, Carlo Bellabarba, Richard Bransford, Marcelo Vilela","doi":"10.1055/s-0032-1328145","DOIUrl":"https://doi.org/10.1055/s-0032-1328145","url":null,"abstract":"Selected abstracts delivered at the 10th Annual AOSpine North America Fellows Forum Consistent with EBSJ’s commitment to fostering quality research, we are pleased to feature some of the most highly rated abstracts from the 10th Annual AOSpine North America Fellows Forum in Banff, Canada. Enhancing the quality of evidence in spine care means acknowledging and supporting the efforts of young researchers within our AOSpine North America network. We look forward to seeing more from these promising researchers in the future.","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 4","pages":"63-4"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1328145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31333489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In the era of recombinant BMP, does additional anterior stabilization add value to a posterolateral fusion?","authors":"Priyesh Dhoke, Ben Goss, Satyen Mehta, Sanela Stanojevic, Richard Williams","doi":"10.1055/s-0032-1328139","DOIUrl":"https://doi.org/10.1055/s-0032-1328139","url":null,"abstract":"ABSTRACT\u0000 Study design: Retrospective cohort study. Clinical question or objective: Is there a benefit to additional transforaminal lumbar interbody fusion (TLIF) if a solid posterolateral (PL) fusion can be achieved with routine bone morphogenetic protein (BMP) use in low-grade spondylolisthesis? Methods: We performed a retrospective review of patients who had undergone surgery for grade I or II lumbar spondylolisthesis stratified into two groups. Group 1 had 46 patients who underwent TLIF along with PL instrumented fusion. Group 2 had 40 patients who underwent PL instrumented fusion alone. In both groups, adequate posterior decompression with pedicle screw instrumentation was performed and rhBMP-7 was used. All patients were evaluated clinically using the Oswestry Disability Index (ODI) and by independent radiological examination at 3 and 12 months. Results: At a minimum follow-up of 12 months, there was no statistically significant difference in the rate of fusion. In addition, there were no differences in the proportion of patients who had a minimal clinically significant difference in their ODI. There was a similar rate of complications between each cohort. Conclusions: The use of BMP was associated with a high rate of PL lumbar fusion. In the presence of a PL fusion, there appears to be little clinical benefit to additional anterior TLIF in degenerative spondylolisthesis. Final class of evidence-treatment Study design RCT Cohort • Case control Case series Methods Concealed allocation (RCT) Intention to treat (RCT) Blinded/independent evaluation of primary outcome F/U ≥ 85% • Adequate sample size • Control for confounding Overall class of evidence III The definiton of the different classes of evidence is available here.","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":" ","pages":"21-5"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1328139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40225230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient expectations, outcomes and satisfaction: related, relevant or redundant?","authors":"Paul Licina,&nbsp;Michelle Johnston,&nbsp;Laura Ewing,&nbsp;Mark Pearcy","doi":"10.1055/s-0032-1328138","DOIUrl":"https://doi.org/10.1055/s-0032-1328138","url":null,"abstract":"<p><strong>Study design: </strong> A prospective case series of patients undergoing lumbar spine surgery.</p><p><strong>Objective: </strong> Is there a correlation between patients' expectations before lumbar surgery, postoperative outcomes, and satisfaction levels?</p><p><strong>Methods: </strong> A prospective study of 145 patients undergoing primary, single-level surgery for degenerative lumbar conditions was conducted. Oswestry Disability Index, back Visual Analog Scale (VAS), and leg VAS were assessed preoperatively and at 6 weeks and 6 months after surgery. Patients' expectations were measured preoperatively by asking them to score the level of pain and disability that would be least acceptable for them to undergo surgery and be satisfied. Satisfaction was assessed 6 weeks postoperatively with a Likert scale. Differences in patient expectations between actual and expected improvements were quantified.</p><p><strong>Results: </strong> Most patients had a clinically relevant improvement, but only about half achieved their expectations. Satisfaction did not correlate with preoperative pain or disability, or with patient expectation of improvement. Instead, satisfaction correlated with positive outcomes.</p><p><strong>Conclusions: </strong> Patient expectations have little bearing on final outcome and satisfaction. [Table: see text].</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":" ","pages":"13-9"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1328138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40228248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-center results at 7 years of prospective, randomized ProDisc-C total disc arthroplasty versus anterior cervical discectomy and fusion for treatment of one level symptomatic cervical disc disease.","authors":"Thomas Kesman,&nbsp;Daniel Murrey,&nbsp;Bruce Darden","doi":"10.1055/s-0032-1328144","DOIUrl":"https://doi.org/10.1055/s-0032-1328144","url":null,"abstract":"<p><p>Consistent with EBSJ's commitment to fostering quality research, we are pleased to feature some of the most highly rated abstracts from the 10th Annual AOSpine North America Fellows Forum in Banff, Canada. Enhancing the quality of evidence in spine care means acknowledging and supporting the efforts of young researchers within our AOSpine North America network. We look forward to seeing more from these promising researchers in the future.</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 4","pages":"61-2"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1328144","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31333488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"T8 spinal cord transection in a 6-year-old child.","authors":"Selvon F St Clair,&nbsp;Michael Silverstein,&nbsp;Isador Lieberman","doi":"10.1055/s-0032-1327811","DOIUrl":"https://doi.org/10.1055/s-0032-1327811","url":null,"abstract":"<p><strong>Study design: </strong> Case report.</p><p><strong>Objective: </strong> To describe a case of spinal cord transection in a 6-year-old child.</p><p><strong>Background information: </strong> Non-missile injury of the spinal cord is not common and its incidence varies according to the country. In addition, to our knowledge, there are no published reports of spinal cord injury (SCI) from a penetrating nail. Here, we report the case of a child who developed complete SCI because of cord transection by a nail.</p><p><strong>Methods: </strong> A detailed history and physical examination were performed along with careful review of the patient's medical records. In addition, a review of the literature was conducted to assess the incidence and treatment of similar injuries.</p><p><strong>Case description: </strong> A 6-year-old boy was admitted to the hospital after falling from a tree and landing on a nail. His physical examination revealed an emaciated child with multiple decubitus ulcers, lying on his side in bed. Visible was a well-healed posterior puncture wound at the T8 vertebral level. On neurological examination, the patient had 0/5 muscle strength in his lower extremities, symmetrical areflexia, and hypoesthesia below the T8 level. Plain x-ray of the thoracolumbar spine was normal. Magnetic resonance imaging revealed a transected spinal cord at the T8 vertebra, consistent with his nail puncture wound.</p><p><strong>Discussion: </strong> This report describes an unusual case of a complete SCI in a pediatric patient caused by penetrating trauma from a nail. To our knowledge, this is the first case to report on complete SCI due to trauma from a nail.</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 3","pages":"57-61"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1327811","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31334064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of deep vein thrombosis after major spine surgeries with no mechanical or chemical prophylaxis.","authors":"Sreedharan Namboothiri","doi":"10.1055/s-0032-1327807","DOIUrl":"https://doi.org/10.1055/s-0032-1327807","url":null,"abstract":"<p><strong>Study design: </strong> Retrospective cohort study.</p><p><strong>Clinical question: </strong> What is the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) after major spine surgery when no prophylactic measures were used?</p><p><strong>Methods: </strong> A prospective evaluation of 121 patients who underwent 128 major spine surgeries was conducted to determine the incidence of clinically identifiable DVT. As a matter of practice, no patient was given thromboprophylaxis, either mechanical or chemical.</p><p><strong>Results: </strong> Only one patient developed the signs and symptoms of DVT, which was further confirmed by a Doppler study. The overall incidence of DVT was 0.78%. There was no clinically evident case of PE.</p><p><strong>Conclusions: </strong> Considering the low rate of incidence of DVT and PE, routine screening and prophylaxis for DVT appears unwarranted in major spine surgery. [Table: see text].</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":" ","pages":"29-33"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1327807","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40227353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual fibular allograft dowel technique for sacroiliac joint arthrodesis.","authors":"Robert A McGuire,&nbsp;Zenggan Chen,&nbsp;Kevin Donahoe","doi":"10.1055/s-0032-1327806","DOIUrl":"https://doi.org/10.1055/s-0032-1327806","url":null,"abstract":"ABSTRACT Study design: Retrospective case series. Objective: To assess fusion rates in patients with sacroiliac joint (SIJ) pain following a minimally invasive technique using fibular dowel allograft. Methods: Thirty-seven consecutive patients (mean age: 42.5 years [range, 23–63 years]) with SIJ pain treated with 38 minimally invasive elective SIJ arthrodeses were retrospectively reviewed using chart and x-ray data. The fusion procedure consisted of minimal muscle stripping over the posterior SIJ and insertion of a cranial and caudal fibular dowel graft across the joint following placement of Steinmann pins. Fusion was deemed to be present when bone bridging trabeculae could be seen crossing the SIJ on either oblique x-rays or by computed tomographic scan. Patients were followed-up for a mean of 52 months (range, 24–62 months). Visual Analog Scale (VAS) was used to monitor clinical pain improvement. Results: Thirty-four patients with SIJ arthrodeses (89.5%) healed and led to substantial improvement in VAS pain scores (preoperative 9.1, postoperative 3.4) (P < .001). This improvement in VAS occurred over a 6-month period and was sustained through subsequent follow-up. Nonunion occurred in four patients with SIJ (10.5%). Each SIJ nonunion was successfully treated by secondary autogenous bone grafting and compression screw fixation. Conclusions: In patients with primary low back pain attributable to the SIJ, a minimally invasive, dual fibular dowel graft provided high rates of fusion and improved pain scores.","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":" ","pages":"21-8"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1327806","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40227409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repetitive transforaminal steroid injections in cervical radiculopathy: a prospective outcome study including 140 patients.","authors":"Liselotte Persson,&nbsp;Leif Anderberg","doi":"10.1055/s-0032-1327805","DOIUrl":"https://doi.org/10.1055/s-0032-1327805","url":null,"abstract":"<p><strong>Study design: </strong> Prospective case series.</p><p><strong>Objective: </strong> To evaluate the effect of three repetitive transforaminal steroid injections in a large series of selected patients with cervical radiculopathy caused by spondylosis.</p><p><strong>Methods: </strong> Consecutively, 140 patients with long-lasting medical history, clinical findings, and MRI indicating a cervical nerve root origin based on degenerative disease and a positive selective transforaminal diagnostic nerve root blocks with local anesthetics resulting in at least 50% temporary arm pain reduction were included. Before treatment started, patients underwent a clinical examination by a neurosurgeon. All patients were followed-up and evaluated by one physiotherapist at the neurosurgery outpatient clinic. A designed outcome questionnaire including Neck Disability Index (NDI), Symptoms Frequency Index, and Visual Analog Scale for pain intensity were used. A series of three transforaminal steroid injections, with 3 weeks in between, were performed by a neuroradiologist using image intensifier guidance in an x-ray suite. At 12-14 weeks after the first injection, follow-up was performed. Criteria for positive response to the treatment was >50% radicular arm pain reduction. Except for occasional painkillers, no other treatment was given to the patients.</p><p><strong>Results: </strong> Positive response to the treatment was achieved in 49% (n = 69) with a significant difference in NDI and pain intensity between responders and nonresponders.</p><p><strong>Conclusions: </strong> Repetitive transforaminal steroid injections may reduce symptoms (frequency, intensity, and fewer limitations of daily living activities) of radiculopathy in patients with degenerative disease in the cervical spine at a short time follow-up. [Table: see text].</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":" ","pages":"13-20"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1327805","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40227854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eliminating bias/living with bias?","authors":"Jens Chapman","doi":"10.1055/s-0032-1327802","DOIUrl":"https://doi.org/10.1055/s-0032-1327802","url":null,"abstract":"Message from the Editor—Eliminating bias/living with bias? The scientific method and elements of bias are fundamentally at odds with one another. While the prior seeks to identify truth through objective analysis, the latter wishes to prove one’s preconceptions through artificially created or filtered observations. Both the scientific method and bias are purpose-driven notions, both serve an intrinsic value. Arguably the more general and truly-lasting societal value is derived from our attempts at approximating truth through scientific methodology, compared with the more selfserving notions of reaffirming our preconceptions through bias. But what if we cannot really separate the two entities—the scientific method and bias? We have explored the theme of bias in previous EBSJ editorials from the perspectives of investigator, commercial, and even publisher bias [1]. We have also learned that characteristics, which favor publication in major scientific medical journals, are United States–based articles that report good outcomes and are commercially funded [2]. Efforts to eliminate bias for the greater good of medicine are still far from complete but the movement to ‘rate’ research based on its Class of Evidence (CoE) is important, as it is basically a rating of the presence of bias. Please look through the Science in Spine article in this EBSJ issue on “Class or level of evidence” by Dettori (page 9–12). Without oversimplifying its content, the entire article underscores the value of a ‘high-class’ study compared with a ‘lower- class evidence’ by enumerating the incessant awareness it takes to eliminate bias with every step of the way of a research project and why the rating of the evidence is so important. Ultimately it is bias-free evidence that reveals the truth behind a hypothesis, shows previously unknown cross-connections, and allows us to rationally formulate new and more effective treatments. The thought of improving upon nature through our medical interventions is perhaps one of the core motivators that has led us into the healthcare field in the first place. As physicians and healthcare providers, we by nature tend to be more optimists, we hope for improvement with our patients, and value positive achievements. However, this disposition may also lead us to displace negative experiences. Perhaps this is a helpful protective phenomenon as it provides us with capacity to move onward. But what if this core proclivity toward optimism is a problem in itself by introducing bias not only in our clinical medicine practices but also in our approach toward research? This unsettling thought was raised by Emerson et al (full disclosure: some of the authors are fellow employees at the University of Washington) in their recent article titled “Testing for a positive outcome bias in peer review: a randomized controlled trial.” With permission from the editors-inchief of two leading orthopaedic publications, JBJS and CORR, the authors submitted a fabricated ","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 3","pages":"5-6"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1327802","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31334058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary.","authors":"Vincent Arlet","doi":"10.1055/s-0032-1327803","DOIUrl":"https://doi.org/10.1055/s-0032-1327803","url":null,"abstract":"Dear Editor, I read with great interest the case report from Silverstein and colleagues [1] about the surgical technique used to correct a congenital kyphosis in Uganda. Having been involved in the care of spinal deformities in developing countries for the last 7 years, I would like to comment on this interesting case. First, I commend the authors for performing such a procedure (pedicle subtraction osteotomy [PSO] at the cord level) with this nice immediate postoperative result. Performing complex spine surgery in such environment requires specific talents that range from extraordinary personal relationship skills (built over the years with the local surgical team), to very skilled surgeons used to perform such techniques of PSO at this level. However, a few points need to be clarified. Diagnosis The diagnosis from the x-rays available appears to show a congenital kyphosis type 2 with lack of segmentation. Besides there seems to be multiple levels of defect of segmentation on the x-rays as it seems that the level T12– L1 and L1–L2 are fused anteriorly as well. The curve measured 65°, as indicated by the authors. Such a defect of segmentation will very likely progress in a 10-year-old girl who is most likely premenarchal; thus, I agree with the need to correct the deformity. Her neurological picture is intriguing and I think this should be emphasized in the text as I am not aware of such a case causing myelopathy at such a young age as opposed to type I congenital kyphosis (defect of formation), which is notorious for neurologi-cal complications if not stabilized. In the articles by McMaster and Singh [2] and Winter et al [3], all neurological complications from congenital kyphosis were observed in type 1 or 3 (mixed types) and none from type 2 [4]. Therefore, I have some serious doubts as to this congenital kyphosis causing neurological symptoms in this case. It is unfortunate that no MRI was available to rule out other causes of myelopathy or gait disturbance. If Silverstein et al [1] believed that kyphosis was responsible for myelopathy then a simple myelogram with a lateral shoot through x-rays could have been helpful. Spinal cord monitoring In the last 10 years it has become state of the art to perform spinal deformity correction with spinal cord monitoring (SCM). Performing spinal deformity surgery without SCM is obviously possible and one can use the Stagnara wake up as the only …","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 3","pages":"7-8"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1327803","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31334059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}